STEP 4Removal of central pancreas

Transection of pancreas: Stay sutures are placed on the superior and inferior pancreatic margins just to the right and left of the proximal and distal lines of division to occlude the superior and inferior pancreatic vessels running transversely in the parenchyma.

The pancreas is divided by scalpel using a V-shaped incision on the right side of the tumor to facilitate closure in a fish-mouth fashion; the pancreas is transected 1 cm to the left of the tumor with suture ligation of the larger arterial bleeders in the cut edge (A-1).

The pancreatic duct in the right side of the remnant gland is suture-ligated with 5-0 non-absorbable monofilament, and the pancreatic tissue closed in a fish-mouth fashion with interrupted 3-0 synthetic absorbable sutures (A-2).

A very thin neck of pancreas can also be closed with a stapler and bleeding from small arteries controlled with absorbable synthetic stitches; the pancreatic duct is still identified and suture-ligated individually with 5-0 non-absorbable monofilament (A-3).

The right-sided limit of a central pancreatectomy is the left side of the gastroduo-denal artery; transecting the pancreas to the right of the gastroduodenal artery can injure the common bile duct.

The specimen is sent to the pathologist for frozen section examination and for checking the right and left resection margins. A stitch on one margin will orient the specimen for the pathologist.

Distal Pancreatectomy Main Duct Ligation

STEP 5

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